Since the first case of human immunodeficiency virus (HIV) infection was reported in Korea in 1985, the number of HIV patients has risen steadily and reached 5,323 in December 2007. Consequently, multiple opportunistic infections have become a significant clinical problem. Diseases of the gastrointestinal tract are among the most frequent complications of acquired immunodeficiency syndrome (AIDS) and cause morbidity in patients with HIV infection. Opportunistic infections are the leading cause of esophageal complaints. Candida albicans is the most frequently identified cause of esophageal symptoms, followed by herpes simplex virus (HSV) and cytomegalovirus (CMV) infections. Esophageal candidiasis often occurs concurrently with other infectious esophageal disorders. Simultaneous esophageal infection with HSV, CMV, and Candida spp. is rare. We report a case of combined HSV, CMV, and candidal esophagitis in an AIDS patient. He was treated with highly active antiretroviral therapy (HAART) and the appropriate antiviral and antifungal agents.
Acquired Immunodeficiency Syndrome ; Antifungal Agents ; Antiretroviral Therapy, Highly Active ; Candida ; Candida albicans ; Candidiasis ; Cytomegalovirus ; Esophagitis ; Gastrointestinal Tract ; Herpes Simplex ; HIV ; HIV Infections ; Humans ; Korea ; Methylmethacrylates ; Opportunistic Infections ; Polystyrenes ; Simplexvirus

BACKGROUND: It has been reported that younger patients with lung cancer have characteristic features that differ from those in older patients. The prognosis for young patients with this disease is controversial. This study aimed to determine the clinicopathological characteristics, the survival rate, and the risk factors associated with the overall survival rate in younger patients with lung cancer. METHODS: The records of 120 young(age≤40) patients with histologically confirmed lug cancer in the Korea Cancer Center Hospital(KCCH) between Jan. 1992 to 1998, 120 older(age>40) patients were randomly selected as the controls. RESULTS: More female patients(45.0% vs. 20.0%, p<0.001) and more adenocarcinoma cases(64.2% vs. 38.3%, p<0.001) were found in the younger group, when compared to the older patients. In NSCLC, advanced disease(stage III B and IV) was more common in the younger patients(90.2%) than in the older patients(62.7%) (p<0.001). The Median survival was 8.6 months in the younger patients and 12.2 months in the older(p=0.003). In a multivariate analysis, only the advanced-stage was an independent negative prognostic factor. CONCLUSION: Lung cancer in the younger age group presents with a more advanced stage resulting in a poor survival rate, which suggests that lung cancer in this population is more aggressive than in older patients.
Adenocarcinoma ; Female ; Humans ; Korea ; Lung Neoplasms* ; Lung* ; Multivariate Analysis ; Prognosis ; Risk Factors ; Survival Rate

Cytomegalovirus (CMV) colitis is a rare event that has been described mainly in immunocompromised patients who are on immunosuppressive medication or they have HIV infection. CMV colitis manifesting in an immunocompetent host is exceedingly rare, but this has occasionally been described in pregnant patients and patients with chronic renal failure. Pseudomembranous colitis (PMC) is known to develop with long-term antibiotic administration and it is caused by the abnormal overgrowth of toxin-producing Clostridium difficile that colonize the large bowel. Appropriate diagnostic testing and early treatment may avert morbidity and mortality. A case of the simultaneous occurrence of cytomegalovirus and Clostridium difficile colitis in an immunocompetent adult has not yet been reported in the Koran medical literature. We report here on a case of the simultaneous occurrence of cytomegalovirus and Clostridium diffiicle colitis in an immunocompetent Korean adult.
Adult ; Clostridium ; Clostridium difficile ; Colitis ; Colon ; Cytomegalovirus ; Diagnostic Tests, Routine ; Enterocolitis, Pseudomembranous ; HIV Infections ; Humans ; Immunocompromised Host ; Kidney Failure, Chronic

Fibroblast growth factor 21 (FGF21) is an attractive target for treating metabolic disease due to its wide-ranging beneficial effects on glucose and lipid metabolism. Circulating FGF21 levels are increased in insulin-resistant states; however, endogenous FGF21 fails to improve glucose and lipid metabolism in obesity, suggesting that metabolic syndrome is an FGF21-resistant state. Therefore, transcription factors for FGF21 are potential drug targets that could increase FGF21 expression in obesity and reduce FGF21 resistance. Despite many studies on the metabolic effects of FGF21, the transcriptional regulation of FGF21 gene expression remains controversial and is not fully understood. As the FGF21 transcription factor pathway is one of the most promising targets for the treatment of metabolic syndrome, further investigation of FGF21 transcriptional regulation is required.
Diabetes Mellitus ; Fibroblast Growth Factors* ; Gene Expression ; Glucose ; Insulin Resistance ; Lipid Metabolism ; Metabolic Diseases ; Obesity ; Transcription Factors

Inflammatory myofibroblastic tumor (IMT) is a rare reactive lesion characterized by the feature of myofibroblasts and a mixed inflammatory infiltrate that rarely undergoes malignant transformation. Extrapulmonary IMTs in children have been described involving the mesentery, omentum, retroperitoneum, abdominal soft tissues, liver, bladder, mediastinum, head and neck, extremity, appendix, and kidney. Medical records of children treated with abdominal IMT between 1985 and 2005 were reviewed retrospectively. Seven children were treated for IMT with the mean age of 3y 2m (range, 1y 1m to 14y). Tumors were located in transverse mesocolon (n=2), omentum (n=1), porta hepatis (n=2), complex site (antrum, duodenum, common bile duct, porta hepatis) (n=2). The symptoms included abdominal mass, fever, jaundice, abdominal pain and anemia. The masses were excised totally in transverse mesocolon, omentum IMT and there is no evidence of recurrence (follow-up periods: 6y 8m, 8y 9m, 4y 10m). In porta hepatis IMT, liver transplantations were performed and there is no evidence of recurrence (follow period: 6y 8m, 8y 7m). In one case of complex site IMT, partial excision of mass was performed and he still survived with no change of the residual tumor during follow-up period. The other one of complex site IMT denied further treatment after the biopsy. In conclusion, complete surgical excision including liver transplantation and close follow-up are mandatory for the abdominal IMT in child.
Abdominal Pain ; Anemia ; Appendix ; Biopsy ; Child ; Common Bile Duct ; Duodenum ; Extremities ; Fever ; Follow-Up Studies ; Head ; Humans ; Jaundice ; Kidney ; Liver ; Liver Transplantation ; Mediastinum ; Medical Records ; Mesentery ; Mesocolon ; Myofibroblasts ; Neck ; Neoplasm, Residual ; Omentum ; Recurrence ; Retrospective Studies ; Urinary Bladder

This report describes a case of yellow fever vaccine-associated viscerotropic disease (YEL-AVD) that occurred after vaccination in a 23-year-old male. Seven days after vaccination, our patient presented with fever, myalgia, and nausea. The IgM enzyme-linked immunosorbent assay (ELISA) for yellow fever virus was positive. After a 24 day hospitalization, he recovered and was discharged. Yellow fever is a viral hemorrhagic febrile illness caused by a flavivirus and transmitted by mosquitoes. The clinical presentation ranges from a mild febrile illness to a serious infection, leading to hepatic and renal failure, myocardial injury, hemorrhage, and shock, with a case fatality rate of 20-30%. Because yellow fever is a potentially fatal disease, vaccination is encouraged for people traveling to high-risk areas. Although considered a safe vaccine, severe adverse reactions have been reported. In 2001, rare, but severe, acute viscerotropic disease following vaccination was first described. We report the case of a 23-year-old male with fever and hepatitis following vaccination with 17D yellow fever vaccine.
Culicidae ; Enzyme-Linked Immunosorbent Assay ; Fever ; Flavivirus ; Hemorrhage ; Hepatitis ; Hospitalization ; Humans ; Immunoglobulin M ; Male ; Nausea ; Renal Insufficiency ; Shock ; Vaccination ; Yellow Fever ; Yellow Fever Vaccine ; Yellow fever virus ; Young Adult

BACKGROUND/AIMS: The prevalence of single-person households has rapidly increased in Korea. Individuals living alone and in rural areas may have a higher risk of various metabolic diseases due to differences in lifestyle. However, few studies have investigated the association of household size and residential area with health-related problems. This study aimed to evaluate the association of household size and residential area with risk of osteoporosis in postmenopausal women. METHODS: This cross-sectional study enrolled 3,058 postmenopausal women from the 2008 to 2011 Korea National Health and Nutrition Examination Survey (KNHANES). We examined the association between bone mineral density (BMD) and household size and residential area. RESULTS: Individuals living in rural areas had significantly lower BMD of the lumbar spine than those living in an urban area. Subsequently, we divided the participants into four groups according to household size and residential areas. Lumbar spine BMD was significantly lower in individuals living in rural single-person households than those in urban households with two or more individuals, even after adjustment for multiple confounding factors. In addition, individuals in rural single-person households had significantly greater odds of osteoporosis in the lumbar spine than those in urban households with two or more residents. CONCLUSIONS: Individuals in rural single-person households had significantly lower BMD and greater odds of osteoporosis in lumbar spine than urban households with two or more individuals. The results of this study suggest that individuals living in rural single-person households may benefit from more careful screening for osteoporosis.
Bone Density ; Cross-Sectional Studies ; Family Characteristics* ; Female ; Humans ; Korea* ; Life Style ; Mass Screening ; Metabolic Diseases ; Nutrition Surveys* ; Osteoporosis* ; Prevalence ; Spine

BACKGROUND: Adrenal incidentaloma is an adrenal neoplasm frequently encountered in clinical practice for which detection rates have recently increased. We describe here the clinical characteristics of adrenal incidentalomas. METHODS: A retrospective study was performed examining the age, sex, location, size, function, and the histological findings for 348 patients with an adrenal mass discovered incidentally on computed tomography (CT) undertaken for health examination or nonadrenal disease from August 2005 to May 2012. RESULTS: Patients consisted of 156 males (44.8%) and 192 females (55.2%), aged between 20 and 86. Adrenal masses were most commonly found in patients in their sixth decade (32.5%). Regarding the location of the masses, 62.0% were found in the left adrenal gland, 30.2% were found in the right, and 7.8% were found bilaterally. Of all of the masses analyzed, 87.1% were 1 to 4 cm in size, and an adenoma-like appearance was the most common finding (75.3%) seen on CT scans. Hormonal analysis showed that 82.2% of the masses were nonfunctioning, 6.0% were diagnosed as subclinical Cushing's syndrome, 4.6% were aldosterone-producing adenomas, and 7.2% were pheochromocytomas. Adrenalectomy was performed in a total of 69 patients having adenoma (50.7%), pheochromocytoma (24.6%), and carcinoma (4.3%). CONCLUSION: The characteristics of benign, malignant, nonfunctional, and functional adrenal masses that were incidentally found at our hospital were similar to those presented in other studies.
Adenoma ; Adrenal Gland Neoplasms ; Adrenal Glands ; Adrenalectomy ; Aged ; Cushing Syndrome ; Female ; Humans ; Male ; Pheochromocytoma ; Retrospective Studies

Fever of unknown origin (FUO) is not infrequently a diagnostic dilemma for clinicians. Common infectious causes include endocarditis and abscesses in adults, and noninfectious causes include neoplasms and certain collagen vascular diseases. Endocrine causes of FUO are rare. The only endocrine disorder likely to present as FUO is subacute thyroiditis. Subacute thyroiditis usually occurs in middle-aged women as viral prodrome, neck tenderness, classic symptoms of thyrotoxicosis, and an elevated erythrocyte sedimentation rate. The patient may have abrupt onset of fever and chills with complaints of thyroid pain, or only low-grade fever with poorly characterized anterior neck pain. We present a case of FUO in a 48-year-old female who had had fever and neck pain for more than one month. Despite an extensive evaluation, the patient had persistent fever and no cause was found, with the exception of subacute thyroiditis. The fever resolved from the second day of treatment with low-dose steroid (prednisolone, 10 mg per day). This case illustrates that subacute thyroiditis should be considered in cases of FUO.
Abscess ; Adult ; Blood Sedimentation ; Chills ; Collagen ; Endocarditis ; Female ; Fever ; Fever of Unknown Origin ; Humans ; Neck ; Neck Pain ; Thyroid Gland ; Thyroiditis, Subacute ; Thyrotoxicosis ; Vascular Diseases

Intraductal papillary mucinous tumor (IPMT) of the pancreas is a spectrum of conditions ranging from benign to malignant. It is known that the biologic behavior of IPMT is slower and less aggressive than that of pancreatic ductal carcinoma. We report a case of IPMT of pancreas resected 5 years after diagnosis. The carcinoma remained localized without evident stromal invasion or lymph node metastasis with the background of adenoma, suggesting a adenomacarcinoma sequence. This is a case report that may be helpful to study the natural history of IPMT, particularly slow progression of IPMT.
Adenoma ; Carcinoma, Pancreatic Ductal ; Diagnosis* ; Lymph Nodes ; Mucins* ; Natural History ; Neoplasm Metastasis ; Pancreas*